There are two main types of vertebral augmentation surgery for compression fractures in the spine: vertebroplasty and kyphoplasty.

Vertebroplasty Procedure

The procedure known as vertebroplasty is generally done with the patient sedated but awake, in an X-ray suite or an operating room.

In vertebroplasty:

  • The patient is positioned face down (prone), which may improve the overall vertebral alignment as compared to standing if the fracture is relatively acute and unstable.
  • A thin needle cannula is placed into the vertebra using X-ray guidance.
  • A bone cement is injected under pressure directly into the fractured vertebra.
  • Once in position, the cement hardens in about 10 minutes, congealing the fragments of the fractured vertebra and providing immediate stability.

In this vertebral augmentation procedure, the material is placed directly into the fracture site to attempt to stabilize the site. There is no manipulation of the vertebra from within using instruments.

The cement injected moves between the fracture fragments and binds them together in the position that they are in.

See Vertebroplasty Procedure


Kyphoplasty Procedure

The procedure known as balloon kyphoplasty is commonly done under general anesthesia in an operating room, although kyphoplasty can also be done under a local anesthesia.

In kyphoplasty:

  • The patient is positioned face down (prone) on the operating table.
  • A balloon catheter, similar to the one used in angioplasty of the heart, is guided into the vertebra using X-ray guidance, and inflated with a liquid under pressure.
  • As the balloon inflates, it can help to actively restore the collapse in the vertebra due to the fracture and can also correct abnormal wedging of the broken vertebra.
  • Once the balloon is maximally inflated, it is deflated and removed, and the cavity created is filled with thicker bone cement under lower pressure than in a vertebroplasty.
  • The cement then hardens in place, with the goal of maintaining any correction of collapse and wedging.

Kyphoplasty may be particularly helpful when there is severe collapse of the broken vertebra or wedging, with more collapse in the front of the spine than the back resulting in the spine tending to tilt forward. By correcting the wedging, kyphoplasty may help restore the spine to a more normal alignment and prevent severe kyphotic ("hunchback") deformity to the spine.

In someone who has had multiple fractures with previous wedging, kyphoplasty can prevent further worsening of the deformity.

New devices and vertebral augmentation procedures have been developed to aid in fracture reduction and cavity creation, so that the balloon catheter is not the only option for kyphoplasty. Permanent non-cement implants can also be used to aid in stabilization and correction of the vertebral collapse.

Dr. Jeffrey Spivak is an orthopedic surgeon and the Director of the Hospital for Joint Diseases Spine Center. He has been a practicing spine surgeon for more than 25 years and specializes in degenerative diseases, deformities, and trauma of the spine.